MSF opened a kala azar project in Vaishali district, in central Bihar, in July 2007. Hajipur, the district capital, where the project is based, has a population of about 700,000. Over four years, around 8,000 people have been successfully treated.

Symptoms of kala azar include fever, loss of appetite, enlarged spleen and liver, and anemia. Infection occurs when the kala azar parasite is transmitted through the bite of a sand fly. Symptoms usually appear around two weeks after the bite.

Taking symptoms into account is important because the rapid test can sometimes show a false negative. This is particularly common in HIV patients who have also contracted kala azar. In such cases, doctors must remove and examine fluid from the spleen and examine in order to confirm whether or not the patient has kala azar.

Complicated kala azar cases are treated at the hospital, including patients suffering from severe anemia, HIV, and severe acute malnutrition, as well as pregnant women, infants, and the elderly. Simple cases are treated on an outpatient basis. Patients receive four intravenous doses of the drug liposomal amphotericin B (LAmB).

Previously, kala azar patients were given the drug SSG, which required a long and toxic treatment. Many people in India and Bangladesh developed resistance to SSG. The current drug used to treat the disease is effective, requires a short course of treatment, and has fewer side effects. The initial cure rate at MSF's project in Sadar Hospital is 98 percent.

A 30-year-old patient receives treatment for post-kala azar dermal leishmanisasis (PKDL), an infection some patients contract after being treated for kala azar, mainly in India and Bangladesh. Although PKDL is relatively painless, it is a reservoir for the kala azar parasite and it must be treated to prevent the disease from spreading.

When kala azar patients also have HIV, the two diseases form a vicious circle that is difficult to break. HIV-positive patients have fewer defenses to fight the kala azar parasite, so treatment failure is more common. At the same time, kala azar further weakens the defenses of HIV patients, increasing their risk of contracting opportunistic infections.

Mukesh, 18, smiled when the doctor told him he would be discharged tomorrow. “If someone I know has kala azar in the future," he said, "I will advise him to come and get treatment at Sadar Hospital. It is the best treatment one can find and totally free of charge.” Mukesh said he plans to rest for a few weeks and then return to Delhi to work as he used to before he became sick.

November 09, 2011

Bihar State, in northeastern India, is a major epicenter of the parasitic disease visceral leishmaniasis—also known as kala azar. Doctors Without Borders/Médecins Sans Frontières (MSF) works in Bihar’s Vaishali district to treat this complicated and deadly disease.